http://journals.lww.com/co-obgyn/pages/viewallmostpopulararticles.aspx
en-usFri, 09 Dec 2016 09:56:31 -0600Wolters Kluwer Health RSS Generatorhttp://images.journals.lww.com/co-obgyn/XLargeThumb.00001703-201612000-00000.CV.jpeghttp://journals.lww.com/co-obgyn/pages/viewallmostpopulararticles.aspx
http://journals.lww.com/co-obgyn/Fulltext/2016/08000/Techniques_in_minimally_invasive_surgery_for.16.aspx
Purpose of review: Surgery can be an important treatment option for women with symptomatic endometriosis. This review summarizes the recommended preoperative work up and techniques in minimally invasive surgery for treatment of deeply infiltrating endometriosis (DIE) involving the obliterated posterior cul-de-sac, bowel, urinary tract, and extrapelvic locations.
Recent findings: Surgical management of DIE can pose a challenge to the gynecologic surgeon given that an extensive dissection is usually necessary. Given the high risk of recurrence, it is vital that an adequate excision is performed. With improved imaging modalities, preoperative counseling and surgical planning can be optimized. It is essential to execute meticulous surgical technique and include a multidisciplinary surgical team when indicated for optimal results.
Summary: Advanced laparoscopic skills are often necessary to completely excise DIE. A thorough preoperative work up is essential to provide correct patient counseling and incorporation of the preferred surgical team to decrease complications and optimize surgical outcomes. Surgical management of endometriosis is aimed at ameliorating symptoms and preventing recurrence.]]>Mon, 01 Aug 2016 00:00:00 GMT-05:0000001703-201608000-00016http://journals.lww.com/co-obgyn/Fulltext/2016/08000/Cigarette_smoking_and_hormones.3.aspx
Purpose of review: The purpose is to provide a summary of the effects of cigarette smoking on steroid hormone metabolism and how it affects female fertility.
Recent findings: Components of tobacco smoke such as polycyclic aromatic hydrocarbons lead to transcriptional upregulation of a number of genes, including members of the cytochrome P450 (CYP) family, in particular CYP1B1 and CYP1A1. In humans, CYP1A1 and CYP1A2 are the primary enzymes catalyzing the 2-hydroxylation of estradiol. This pathway shunts available estrogen away from the more estrogenically potent 16α-hydroxylation to the production of catechol estrogens, mainly 2 and 4 hydroxyestradiol.
Summary: Smoking has multiple effects on hormone secretion and metabolism. These effects are mainly mediated by the pharmacological action of tobacco alkaloids (nicotine and its metabolite cotinine). A strong body of evidence indicates that the negative effects of cigarette smoking on fertility compromises nearly every system involved in the reproductive process.]]>Mon, 01 Aug 2016 00:00:00 GMT-05:0000001703-201608000-00003http://journals.lww.com/co-obgyn/Fulltext/2016/12000/Methods_of_pushing_during_vaginal_delivery_and.4.aspx
Purpose of review: Over the past 20 years, several randomized studies have compared Valsalva and spontaneous pushing techniques during vaginal delivery. This review summarizes current medical knowledge concerning their maternal and fetal consequences, focusing on pelvic and perineal outcomes.
Recent findings: We selected nine randomized controlled trials comparing Valsalva and spontaneous pushing, and a secondary analysis of a randomized controlled trial comparing different methods of perineal protection. Two trials showed that spontaneous pushing reduces the risk of perineal tears, but no firm conclusions can be drawn given the heterogeneity and inconsistent results of these studies. Conflicting results have been reported regarding the duration of the second stage of labor. Pushing technique does not seem to affect episiotomy, instrumental delivery or cesarean rates. Maternal satisfaction seems to be better after spontaneous pushing. Spontaneous pushing appears to have no adverse effects on neonatal well being, and one study showed a significant improvement in prenatal fetal parameters during the expulsive phase.
Summary: Valsalva and spontaneous pushing techniques currently appear comparable in terms of duration, pelvic floor, perineal, and neonatal outcomes. In the absence of strong evidence in favor of either technique, the decision should be guided by patient preference and the clinical situation. Additional, well-designed randomized controlled trials are required.]]>Thu, 01 Dec 2016 00:00:00 GMT-06:0000001703-201612000-00004http://journals.lww.com/co-obgyn/Fulltext/2016/02000/Human_papillomavirus_vaccination_and_primary.11.aspx
No abstract available]]>Mon, 01 Feb 2016 00:00:00 GMT-06:0000001703-201602000-00011http://journals.lww.com/co-obgyn/Fulltext/2014/06000/The_impact_of_lifestyle_behaviors_on_infertility.10.aspx
Purpose of review: The impact of lifestyle behaviors on fertility is poorly understood, as is the impact of specific behaviors on the advanced reproductive technologies. It is vital for healthcare professionals to understand which lifestyle behaviors can have the greatest negative impact in an effort to improve patient recommendations. The purpose of this article is to review the recent research on this topic.
Recent findings: The majority of research in this area is epidemiological; there are a few randomized controlled trials (RCTs) regarding weight loss in infertility patients, but no RCTs on other lifestyle behaviors. High or low BMI, alcohol, vigorous exercise, nicotine, and antidepressant medications may have an adverse impact on fertility. It is unclear whether dietary supplements can have a positive impact on fertility. Patients do not appear to follow recommendations for lifestyle behavior modifications during infertility treatment.
Summary: Healthcare professionals need to be more effective in making lifestyle behavior recommendations for infertility patients, including those receiving treatment.
Video abstract: http://links.lww.com/COOG/A13 .]]>Sun, 01 Jun 2014 00:00:00 GMT-05:0000001703-201406000-00010http://journals.lww.com/co-obgyn/Fulltext/2016/02000/Securing_global_access_to_innovations_in_women_s.2.aspx
No abstract available]]>Mon, 01 Feb 2016 00:00:00 GMT-06:0000001703-201602000-00002http://journals.lww.com/co-obgyn/Fulltext/2015/04000/What_contributes_to_disparities_in_the_preterm.5.aspx
Purpose of review: In countries with comparable levels of development and healthcare systems, preterm birth rates vary markedly – a range from 5 to 10% among live births in Europe. This review seeks to identify the most likely sources of heterogeneity in preterm birth rates, which could explain differences between European countries.
Recent findings: Multiple risk factors impact on preterm birth. Recent studies reported on measurement issues, population characteristics, reproductive health policies as well as medical practices, including those related to subfertility treatments and indicated deliveries, which affect preterm birth rates and trends in high-income countries. We showed wide variation in population characteristics, including multiple pregnancies, maternal age, BMI, smoking, and percentage of migrants in European countries.
Summary: Many potentially modifiable population factors (BMI, smoking, and environmental exposures) as well as health system factors (practices related to indicated preterm deliveries) play a role in determining preterm birth risk. More knowledge about how these factors contribute to low and stable preterm birth rates in some countries is needed for shaping future policy. It is also important to clarify the potential contribution of artifactual differences owing to measurement.]]>Wed, 01 Apr 2015 00:00:00 GMT-05:0000001703-201504000-00005http://journals.lww.com/co-obgyn/Fulltext/2016/12000/Update_on_emergency_contraception.12.aspx
Purpose of review: Emergency contraception provides a critical and time-sensitive opportunity for women to prevent undesired pregnancy after intercourse. Both access and available options for emergency contraception have changed over the last several years.
Recent findings: Emergency contraceptive pills can be less effective in obese women. The maximum achieved serum concentration of levonorgestrel (LNG) is lower in obese women than women of normal BMI, and doubling the dose of LNG (3 mg) increases its concentration maximum, approximating the level in normal BMI women receiving one dose of LNG. Repeated use of both LNG and ulipristal acetate (UPA) is well tolerated. Hormonal contraception can be immediately started following LNG use, but should be delayed for 5 days after UPA use to avoid dampening the efficacy of UPA. The copper intrauterine device (IUD) is the only IUD approved for emergency contraception (and the most effective method of emergency contraception), but use of LNG IUD as emergency contraception is currently being investigated. Accurate knowledge about emergency contraception remains low both for patients and healthcare providers.
Summary: Emergency contraception is an important yet underutilized tool available to women to prevent pregnancy. Current options including copper IUD and emergency contraceptive pills are safe and well tolerated. Significant gaps in knowledge of emergency contraception on both the provider and user level exist, as do barriers to expedient access of emergency contraception.]]>Thu, 01 Dec 2016 00:00:00 GMT-06:0000001703-201612000-00012http://journals.lww.com/co-obgyn/Fulltext/2016/12000/Editorial_introductions.1.aspx
No abstract available]]>Thu, 01 Dec 2016 00:00:00 GMT-06:0000001703-201612000-00001http://journals.lww.com/co-obgyn/Fulltext/2016/10000/Common_prepubertal_vulvar_conditions.6.aspx
Purpose of review: The purpose of this article is to provide an update for the GP on selected common vulvar concerns in prepubertal girls. Presentation, diagnostic criteria, and management of common vulvar conditions will be described. The following conditions are frequently encountered and may pose diagnostic or management challenges if unrecognized.
Recent findings: The article is a review of current literature on pediatric vulvar conditions and was conducted through searching PubMed and published books on this topic. Areas of interest frequently encountered by providers are presented, including vulvovaginitis, genital ulcers, lichen sclerosus, and labial adhesions along with the most recent North American Society for Pediatric and Adolescent Gynecology recommendations for diagnosis and management.
Summary: Vulvar complaints in prepubertal girls are common. Many present with nonspecific symptoms and consequently, the diagnosis may be missed or delayed. Prompt recognition improves long-term outcomes and importantly, provides a positive introduction to longitudinal women's health for young girls.]]>Sat, 01 Oct 2016 00:00:00 GMT-05:0000001703-201610000-00006http://journals.lww.com/co-obgyn/Fulltext/2015/06000/Random_start_ovarian_stimulation_in_patients_with.11.aspx
Purpose of review: Awaiting menses to start ovarian stimulation for oocyte/embryo cryopreservation in patients with cancer may result in a significant delay of cancer treatment that may lead to patients forgoing fertility preservation. The purpose of this review is to describe the new protocols to facilitate the start of ovarian stimulation, including random-start ovarian stimulation.
Recent findings: In random-start protocols, the number of total and mature oocytes retrieved, oocyte maturity rate, mature oocyte yield and fertilization rates are similar to those in conventional (early follicular phase start) protocols. Starting ovarian stimulation in the late follicular or luteal phase did not show any superiority against the other. The presence of corpus luteum or luteal phase progesterone levels did not adversely affect synchronized follicular development, number of mature oocytes retrieved, and/or fertilization rates.
Summary: Random-start ovarian stimulation provides a significant advantage by decreasing total time for the IVF cycle, and in emergent settings, ovarian stimulation can be started at a random cycle date for the purpose of fertility preservation without compromising oocyte yield and maturity.]]>Mon, 01 Jun 2015 00:00:00 GMT-05:0000001703-201506000-00011http://journals.lww.com/co-obgyn/Fulltext/2016/12000/Placental_implantation_abnormalities___a_modern.5.aspx
Purpose of review: Placental implantation abnormalities (PIAs) comprise a large group of disorders associated with significant maternal, fetal, and neonatal morbidity.
Recent findings: Risk factors include prior uterine surgery/myometrial scarring and the presence of placenta previa with or without prior cesarean delivery. Newly identified risk factors include previous prelabor cesarean delivery and previous postpartum hemorrhage. PIAs contribute substantially to preterm birth with prematurity rates ranging from 38 to 82%. Diagnosis is typically made by ultrasound in the second or third trimester; transvaginal ultrasound and color Doppler are useful in evaluating for placental invasion, placental edge thickness, presence of fetal vessels, and cervical length. Suggestive MRI features include increased vascularity, dark T2 bands, uterine bulging, thin or indistinct myometrium, and loss of dark T2 interface. An important first-trimester finding is the implantation of the gestational sac into prior hysterotomy scar (cesarean scar pregnancy). Recommendations for delivery are universally preterm and based on expert opinion. Proposed management strategies are outlined depending on cervical length, distance between internal cervical os and placenta, and placental edge thickness.
Summary: There has been a recent shift in focus to individualizing management in order to improve delivery timing and in some cases even decrease risks associated with prematurity. There is a need for larger prospective studies or randomized trials to show that individualizing care can improve outcomes.]]>Thu, 01 Dec 2016 00:00:00 GMT-06:0000001703-201612000-00005http://journals.lww.com/co-obgyn/Fulltext/2013/02000/Perioperative_care_in_gynecologic_oncology.6.aspx
Purpose of review: To review perioperative care in gynecologic oncology with special emphasis on areas of controversy.
Recent findings: Major gynecologic surgery still represents the cornerstone of management among women diagnosed with gynecologic malignancies. The implementation of clinical guidelines can significantly impact perioperative morbidity and mortality. Preoperative evaluation and preparation allows the surgeon to identify patient risks and develop risk factor modification strategies decreasing delays in preparation and cost and improving patient safety. Preoperative areas of controversy include preoperative testing and evaluation, use of mechanical bowel preparation, prophylactic antibiotics, and use of anticoagulants, and the timing of postoperative feeding.
Summary: In healthy women undergoing gynecologic cancer surgery preoperative evaluation requirements will be minimal. For women with extensive comorbid conditions a more detailed evaluation will be required to decrease perioperative morbidity and mortality. Mechanical bowel preparations should not be required preoperatively. Preoperative administration of antibiotics and anticoagulants should be provided to all patients undergoing major gynecologic cancer surgery.]]>Fri, 01 Feb 2013 00:00:00 GMT-06:0000001703-201302000-00006http://journals.lww.com/co-obgyn/Fulltext/2015/12000/Update_in_family_planning___hardware_and_software.10.aspx
No abstract available]]>Tue, 01 Dec 2015 00:00:00 GMT-06:0000001703-201512000-00010http://journals.lww.com/co-obgyn/Fulltext/2015/12000/Editorial_introductions.1.aspx
No abstract available]]>Tue, 01 Dec 2015 00:00:00 GMT-06:0000001703-201512000-00001http://journals.lww.com/co-obgyn/Fulltext/2014/08000/Maximizing_the_clinical_utility_of_antim_llerian.3.aspx
Purpose of review: To provide an update on the latest clinical applications of serum antimüllerian hormone (AMH) testing with practical approaches to mitigate the impact of significant variability in AMH results.
Recent findings: Recent studies continue to demonstrate that AMH is the best single serum test for ovarian response management with, at most, a weak-to-moderate age-independent association with live-birth rate and time to conception. Data confirm serum AMH levels improve menopause prediction, monitoring of ovarian damage, and identification of women at risk for several ovary-related disorders such as polycystic ovary syndrome and premature or primary ovarian insufficiency. However, it is now recognized that serum AMH results can have dramatic variability due to common, biologic fluctuations within some individuals, use of hormonal contraceptives or other medications, certain surgical procedures, specimen treatment, assay changes, and laboratory calibration differences. Practical guidelines are provided to minimize the impact of variability in AMH results and maximize the accuracy of clinical decision-making.
Summary: AMH is an ovarian biomarker of central importance which improves the clinical management of women's health. However, with the simultaneous rapid expansion of AMH clinical applications and recognition of variability in AMH results, consensus regarding the clinical cutpoints is increasingly difficult. Therefore, a careful approach to AMH measurement and interpretation in clinical care is essential.]]>Fri, 01 Aug 2014 00:00:00 GMT-05:0000001703-201408000-00003http://journals.lww.com/co-obgyn/Fulltext/2013/04000/Editorial_introduction.1.aspx
No abstract available]]>Mon, 01 Apr 2013 00:00:00 GMT-05:0000001703-201304000-00001http://journals.lww.com/co-obgyn/Fulltext/2014/08000/Editorial_introductions.1.aspx
No abstract available]]>Fri, 01 Aug 2014 00:00:00 GMT-05:0000001703-201408000-00001http://journals.lww.com/co-obgyn/Fulltext/2016/12000/Update_on_second_trimester_surgical_abortion.10.aspx
Purpose of review: To review the recent literature on surgical second-trimester abortion, with specific attention to cervical preparation techniques.
Recent findings: Confirming previous studies, a recent retrospective observational cohort study, including 54 911 abortions, estimated the total abortion-related complication rate to be 0.41% for second-trimester or later procedures. Cervical preparation is known to reduce risks associated with second-trimester dilation and evacuation (D&E). When considering adjuncts to osmotic dilators for cervical preparation prior to D&E after 16 weeks, both misoprostol and mifepristone are effective alone and in combination or as adjuncts to osmotic dilators. Misoprostol consistently has been shown to cause more pain and cramping than placebo, but is an effective adjunct to osmotic dilators after 16 weeks. Although mifepristone has fewer side-effects, at its current price, it may not be as cost-effective as misoprostol.
Summary: Second-trimester abortion is safe. The use of mifepristone and misoprostol for second-trimester abortion has improved safety and efficacy of medical and surgical methods when used alone or in combination and as adjuncts to osmotic dilators. An important aspect of D&E, cervical preparation, is not a one-size-fits-all practice; the approach and methods are contingent on patient, provider and setting and should consider all the evidence-based options.]]>Thu, 01 Dec 2016 00:00:00 GMT-06:0000001703-201612000-00010http://journals.lww.com/co-obgyn/Fulltext/2013/02000/Update_on_breast_cancer_surgery_approaches.13.aspx
Purpose of review: This review seeks to review the latest developments in breast cancer surgery.
Recent findings: The manuscript will cover the latest developments in breast conservation therapy such as oncoplastic surgery, partial, and accelerated breast irradiation as well as nipple and areola sparing mastectomies, breast reconstruction, and recent developments in axillary staging.
Summary: At the conclusion of this article the reader will have a comprehensive overview of the latest developments and principles of breast cancer surgical management.]]>Fri, 01 Feb 2013 00:00:00 GMT-06:0000001703-201302000-00013http://journals.lww.com/co-obgyn/Fulltext/2016/12000/Twin_pregnancy_complicated_by_selective_growth.6.aspx
Purpose of review: Selective intrauterine growth restriction (sIUGR) in twin pregnancies presents a complex management problem for the fetal medicine specialist. This review summarizes what is currently known about sIUGR pathophysiology, particularly in monochorionic pregnancies and looks at the results of early trials of fetal intervention in high-risk sIUGR pregnancies.
Recent findings: sIUGR in monochorionic pregnancies is due to unequal placental sharing, but the clinical outcome is determined by the characteristics of the placental vascular anastomoses. Classification of monochorionic sIUGR by umbilical artery Doppler allows interventions to be targeted at high-risk subgroups. The overall survival after diagnosis of early-onset Type II/III sIUGR is similar after the management with cord occlusion and selective laser photocoagulation of connecting vessels.
Summary: Fetal interventions have been shown to be feasible and of potential benefit in early-onset sIUGR in a monochorionic twin pregnancy. Cord occlusion or selective laser photocoagulation of connecting vessels may be offered as an alternative to expectant management or preterm delivery in early-onset severe cases after careful discussion with the parents. Randomized controlled trial evidence is required to make a definitive judgment and to determine the impact of fetal intervention on the neurological outcomes.]]>Thu, 01 Dec 2016 00:00:00 GMT-06:0000001703-201612000-00006http://journals.lww.com/co-obgyn/Fulltext/2016/08000/Editorial_introductions.1.aspx
No abstract available]]>Mon, 01 Aug 2016 00:00:00 GMT-05:0000001703-201608000-00001http://journals.lww.com/co-obgyn/Fulltext/2013/02000/Updates_in_therapy_for_uterine_serous_carcinoma.7.aspx
Purpose of review: Uterine serous carcinoma (USC) is a highly aggressive variant of endometrial cancer with distinct molecular pathogenesis. This review summarizes the rationale behind current clinical approaches, as well as advances made in 2012 toward the elucidation of underlying pathway aberrations and development of targeted therapies that exploit these unique characteristics.
Recent findings: Within the last year, exome-wide analyses have highlighted key mutations to guide rational drug design. The PI3/AKT/mTOR pathway and regulators of cell cycle such as cyclin E/F-box proteins appear to be particularly important. Understanding the epithelial to mesenchymal transition may explain the aggressive pattern of spread frequently observed in this disease. There is heightened evidence for heritable syndromes in association with USC. Conflicting retrospective data continue to emerge regarding optimal therapy, especially for early-stage disease, although prospective studies are underway. Immunotherapies targeting Her2/Neu and vascular endothelial growth factor remain an area of active research. Upregulation of class III β-tubulin observed in paclitaxel-resistant disease may identify candidates for therapy with novel microtubule-stabilizing agents such as epothilones.
Summary: There is an expanding role for contemporary novel approaches in the treatment of USC. The results of clinical investigations using new target antigens, epothilones, and small molecule inhibitors are eagerly awaited.]]>Fri, 01 Feb 2013 00:00:00 GMT-06:0000001703-201302000-00007http://journals.lww.com/co-obgyn/Fulltext/2015/06000/Oocyte_mitochondrial_function_and_reproduction.4.aspx
Purpose of review: Mitochondria are cellular organelles that are required for energy production. Emerging evidence demonstrates their role in oocyte development and reproduction. In this review, we examine recent animal and clinical studies on the role of mitochondria in fertility. We also analyse the impact of assisted reproductive techniques (ARTs) on mitochondrial function and discuss the future clinical implications of mitochondrial nutrients and mitochondrial replacement.
Recent findings: Mitochondria affect all aspects of mammalian reproduction. They are essential for optimal oocyte maturation, fertilization and embryonic development. Mitochondrial dysfunction causes a decrease in oocyte quality and interferes with embryonic development. ART procedures affect mitochondrial function, while mitochondrial nutrients may increase mitochondrial performance in oocytes. New mitochondrial replacement procedures using mitochondria obtained from polar bodies or from the patient's own oogonial stem cells are promising and may address concerns related to the induction of high-levels of heteroplasmy, which could potentially result in negative long-term health effects.
Summary: Optimal energy production is required for oocyte and embryo development, and mitochondrial abnormalities have devastating reproductive consequences. Improvement of oocyte mitochondrial function via intake of compounds that boost mitochondrial activity may have clinical benefits, and mitochondrial replacement could potentially be used for the prevention of mitochondrial diseases.]]>Mon, 01 Jun 2015 00:00:00 GMT-05:0000001703-201506000-00004http://journals.lww.com/co-obgyn/Fulltext/2016/02000/Hormone_replacement_therapy_after_treatment_for_a.7.aspx
Purpose of review: Provision of hormone replacement therapy (HRT) to women following a diagnosis of a gynaecological malignancy is a complex and controversial area associated with a lack of published guidance. As the average age of women affected by gynaecological cancer decreases and survival following provision of effective therapies increases, clinicians face new considerations for longer-term health concerns of patients. Additionally, there is a growing understanding of the influence of tumour biology upon response to cytotoxic therapies and it is essential that we use this knowledge to guide provision of HRT.
Recent findings: Available evidence for ovarian, vulval, cervical, and endometrial cancers demonstrates no excess risk of recurrence in patients taking HRT with the exception of some subtypes of cancer (uterine sarcomas, granulosa cell, and low-grade serous ovarian cancer). Evidence for the incidence of hormone receptor status is suggestive that HRT may be ill-advised in an additional proportion of patients and we recommend characterization of all tumours in patients who may require HRT.
Summary: The risk and benefits of HRT should be evaluated for all women who undergo a premature menopause as a result of gynaecological malignancy to reduce menopausal symptoms and protect against cardiovascular and skeletal morbidity. There is no evidence to suggest a higher rate of disease recurrence in women using HRT in comparison to nonusers in the majority of gynaecological malignancies. Routine histological testing of tumours for hormone receptor status is an achievable goal and may help to stratify patients further into low and high-risk groups for hormone therapy.]]>Mon, 01 Feb 2016 00:00:00 GMT-06:0000001703-201602000-00007http://journals.lww.com/co-obgyn/Fulltext/2015/02000/Next_generation_sequencing_for_hereditary_breast.5.aspx
Purpose of review: To summarize advances in next-generation sequencing and their application to breast and gynecologic cancer risk assessment.
Recent findings: Next-generation sequencing panels of 6–112 cancer-associated genes are increasingly used in patient care. Studies report a 4–16% prevalence of mutations other than BRCA1/2 among patients who meet evidence-based practice guidelines for BRCA1/2 testing, with a high rate (15–88%) of uninterpretable variants of uncertain significance. Despite uncertainty about results interpretation and communication, there is early evidence of a benefit from multiple-gene sequencing panels for appropriately selected patients.
Summary: Multiple-gene sequencing panels appear highly promising for the assessment of breast and gynecologic cancer risk, and they may usefully be administered in the context of cancer genetics expertise and/or clinical research protocols.]]>Sun, 01 Feb 2015 00:00:00 GMT-06:0000001703-201502000-00005http://journals.lww.com/co-obgyn/Fulltext/2013/02000/The_logic_of_the_robotic_revolution_in_gynecologic.2.aspx
No abstract available]]>Fri, 01 Feb 2013 00:00:00 GMT-06:0000001703-201302000-00002http://journals.lww.com/co-obgyn/Fulltext/2016/02000/Moving_from_standardized_to_personalized_boxes_and.5.aspx
Purpose of review: We reviewed the most recent literature on advancements in external beam radiation therapy, brachytherapy, and stereotactic body radiation therapy (SBRT) in the treatment of cervical cancer.
Recent findings: There is a growing transition from three-dimensional-conformal radiation therapy to intensity modulated radiation therapy, and from point A-based two-dimensional prescriptions to three-dimensional volume-based prescriptions in image-guided brachytherapy (IGBT). These advances allow dose-escalation to at-risk regions while sparing normal tissues. Implementation of these techniques is resulting in improved local control and decreased toxicity in patients. With increased local control, the predominant pattern of recurrence is now distant failure, opening the door for SBRT as an emerging treatment option for select patients with limited numbers of metastases (oligometastatic state).
Summary: The integration of IGBT, as well as dose sculpting with intensity modulated radiation therapy, is improving outcomes in women with locally advanced cervical cancer. The clinical evidence strongly supports moving away from point A-based prescriptions and adopting IGBT techniques. The existing data supporting SBRT for gynecologic oligometastases are more limited and require further research before widespread adoption; however, evidence from other disease sites is promising.]]>Mon, 01 Feb 2016 00:00:00 GMT-06:0000001703-201602000-00005http://journals.lww.com/co-obgyn/Fulltext/2016/12000/Family_planning_and_the_Zika_era.8.aspx
Purpose of review: To review the current evidence regarding the impact of the Zika virus epidemic on pregnancy and the implications for family planning and reproductive health services for women in affected countries.
Recent findings: In the past 2 years, over the course of the Zika epidemic, much has been learned about the virus. Specifically in regard to pregnancy, a causative relationship has been established between the Zika virus and adverse fetal outcomes, and sexual transmission of the virus has been documented. Broad recommendations by government agencies and public health officials regarding avoidance of pregnancy for women at risk of acquiring the Zika virus have theoretical and documented implications for abortion and contraception demand and access.
Summary: Additional research is needed to better understand the impact of Zika virus health recommendations and advisories on women's decision making around pregnancy, as well as their impact on demand, access and safety of family planning services.]]>Thu, 01 Dec 2016 00:00:00 GMT-06:0000001703-201612000-00008http://journals.lww.com/co-obgyn/Fulltext/2016/12000/Use_of_dietary_assessment_tools_in_randomized.2.aspx
Purpose of review: Accurate assessment of dietary intake in interventional trials is the key to evaluate changes in dietary behaviour and compliance. We evaluated the use of dietary assessment tools in randomized trials on diet-based interventions in pregnancy by a systematic review.
Recent findings: We updated our previous search (until January 2012) on trials of diet and lifestyle interventions in pregnancy using Medline and EMBASE up to December 2015. Two independent reviewers undertook study selection and data extraction. We assessed the characteristics of dietary assessment tools, the timing and frequency of use and any validation undertaken.
Two-thirds (39/58, 67%) of the included studies used some form of tools to assess dietary intake. Multiple days’ food diaries were the most commonly used (23/39, 59%). Three studies (3/39, 8%) validated the used tools in a pregnant population. Three studies (3/39, 8%) prespecified the criteria for adherence to the intervention. The use of dietary assessment tools was not associated with study quality, year of publication, journal impact factor, type of journal and the study sample size.
Summary: Although self-reporting dietary assessment tools are widely used in interventional dietary trials in pregnancy, the quality and applicability of existing tools are low.]]>Thu, 01 Dec 2016 00:00:00 GMT-06:0000001703-201612000-00002http://journals.lww.com/co-obgyn/Fulltext/2016/12000/Injectable_contraception___updates_and_innovation.9.aspx
Purpose of review: Injectable contraception is a highly effective form of birth control that is globally popular. Recent research has focused on ways to make injectables such as depot medroxyprogesterone acetate (DMPA) more accessible and to improve the side-effect profile of injectables. This review will focus on new directions and approaches to the use of injectable contraception.
Recent findings: Research in the area of injectable contraception has focused on improving access for women through home or self-injection, and also task-shifting and community-based distribution in low-resource areas. Specific to DMPA, studies have focused on lowering the overall dose of medication while maintaining efficacy, and improving drug-delivery systems. More research into the association between DMPA and HIV is needed, and also the effects of administration of DMPA at the time of medication abortion.
Summary: Injectable contraceptives are an important part of the global method mix of highly effective birth control. Improving the accessibility and side effect profile of commodities such as DMPA will make injectables even more valuable for women seeking effective contraception.]]>Thu, 01 Dec 2016 00:00:00 GMT-06:0000001703-201612000-00009http://journals.lww.com/co-obgyn/Fulltext/2016/12000/Haemorrhage_at_caesarean_section___a_framework_for.7.aspx
Purpose of review: Caesarean section rates are increasing across the world. Postpartum haemorrhage is a major cause of morbidity and mortality; major haemorrhage is more common after caesarean delivery. There is a wide range of practice in the prevention and treatment of postpartum haemorrhage at caesarean section. The aim of this review is to summarize current opinion in the management of postpartum haemorrhage at caesarean section.
Recent findings: Recent large randomized controlled trials have shown a possible effect from the routine use of tranexamic acid and ergometrine. Small randomized controlled trials have shown a possible benefit from using carbetocin.
Summary: The impact of postpartum haemorrhage can be reduced by antenatal correction of anaemia. Intraoperative medical management consists of oxytocinon, additional oxytocics +/− tranexamic acid, with at present limited evidence as to the order in which these should be considered. Trials of routine use of cell salvage and tranexamic acid are currently underway.]]>Thu, 01 Dec 2016 00:00:00 GMT-06:0000001703-201612000-00007http://journals.lww.com/co-obgyn/Fulltext/2016/12000/Update_on_abortion_policy.11.aspx
Purpose of review: To review the status of antiabortion restrictions enacted over the last 5 years in the United States and their impact on abortion services.
Recent findings: In recent years, there has been an alarming rise in the number of antiabortion laws enacted across the United States. In total, various states in the union enacted 334 abortion restrictions from 2011 to July 2016, accounting for 30% of all abortion restrictions since the legalization of abortion in 1973. Data confirm, however, that more liberal abortion laws do not increase the number of abortions, but instead greatly decrease the number of abortion-related deaths. Several countries including Romania, South Africa and Nepal have seen dramatic decreases in maternal mortality after liberalization of abortion laws, without an increase in the total number of abortions. In the United States, abortions are incredibly safe with very low rates of complications and a mortality rate of 0.7 per 100 000 women. With increasing abortion restrictions, maternal mortality in the United States can be expected to rise over the coming years, as has been observed in Texas recently.
Summary: Liberalization of abortion laws saves women's lives. The rising number of antiabortion restrictions will ultimately harm women and their families.]]>Thu, 01 Dec 2016 00:00:00 GMT-06:0000001703-201612000-00011